Pathophysiologic explanation for bladder retention in patients after laparoscopic surgery for deeply infiltrating rectovaginal and/or parametric endometriosis
Open accessAbstract
Objective To investigate pathophysiologic mechanisms involved in bladder retention after surgery for rectovaginal deeply infiltrating endometriosis (DIE).Design Retrospective case study.Setting Tertiary referral unit.Patient(s) All patients who presented at our center over the last 5 years with bladder retention developed after laparoscopic surgery for rectovaginal or parametric DIE.Intervention(s) To assess the mechanisms involved in the pathogenesis of this complaint, we performed a step-by-step workup including patient history, clinical neuropelveologic assessment, cystoscopy, and video-urodynamic testing with pelvic floor electromyography and rectomanometry.Main outcome measure(s) Patient Perception of Bladder Condition, International Prostate Symptom Score, and the short-form version of the Urogenital Distress Inventory questionnaires.Result(s) Forty-seven patients were investigated in this study. Mean (±SD) interval from the surgery was 9.5 years (±4.3; range, 7-15 years). Eighteen patients developed acute paralytic motor bladder atony and 5 acute neurogenic bladder atony. Twenty-four patients developed chronic neurogenic bladder atony. The first symptom of chronic bladder retention was reduction of urinary frequency (after 5 years on average). The most frequent complaints that made patients aware of difficulties in voiding were a weak urinary stream (appearing on average 7 years after the procedure) and the need for Valsalva or Crede maneuver (on average 9 years after the procedure).Conclusion(s) Segmental rectum resection with parametric resection exposes the most patients to the risk of bladder motor paralytic retention. However, the most frequent etiology seems to be chronic myogenic destruction secondary to chronic bladder overdistention. Patients after surgery for DIE require a long follow-up, with particular attention paid to postvoid residual volumes.
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Surgical neuroablation of the pelvic plexus may be the principal cause of bladder and rectal dysfunctions.
“In particular the surgical neuroablation of the pelvic plexus may be the principal cause of bladder and rectal dysfunctions [21,22].”
From Post-operative complications and recurrence rate after treatment of bowel endometriosis: Comparison of three techniques (2019) · cites this paper as [21]
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References 8 · Cited by 62
Research works printed but not linked: 2
- [1]1. Possover M, Mallmann P. Follow-up of patients after laparoscopic vaginal resection of the endometriosis of the rectovaginal septum with colorectal anastomosis. J Pelvic Surg 2002;8:83-8.
- [2]2. de Lapasse C, Renouvel F, Chis C, Grosdemouge I, Panel P. Urinary functional and urodynamic preoperative evaluation of patients with deep pelvic surgical- endometriosis: about 12 cases. Gynecol Obstet Fertil 2008;36:272-7.
- Authors
- Possover, M.
- Affiliations
- Aarhus University (DK)
- Corresponding author
- Possover, Marc
- ORCID
- Possover, Marc
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2014-03
- Volume
- 101
- Issue
- 3
- Pages
- 754-758
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2027798785
- Cited by
- 62
- References
- 8
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 6 · 2023: 4 · 2022: 5 · 2021: 2 · 2020: 8 · 2019: 9 · 2018: 6 · 2017: 3 · 2016: 4 · 2015: 4 · 2014: 1
- FWCI
- 4.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Keywords
- bladder retention, deep infiltrating endometriosis, rectovaginal endometriosis, laparoscopic surgery, post-void residual urine, pelvic floor dysfunction, urodynamic assessment, rectal resection
- MeSH terms
- Urinary Bladder, Endometriosis, Female, Follow-Up Studies, Humans, Male, Laparoscopy, Postoperative Complications, Surveys and Questionnaires, Rectum, Retrospective Studies, Vagina, Urinary Retention, Treatment Outcome
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